The Relation Between Hyperglycemia and Outcomes in 2,471 Patients Admitted to the Hospital With Community-Acquired Pneumonia

TLDR

The study aimed to assess whether hyperglycemia at presentation predicts outcomes in non‑ICU patients with community‑acquired pneumonia. A prospective cohort of 2,471 consecutive CAP admissions across six hospitals from 2000 to 2002 was examined. Admission hyperglycemia (>11 mmol/L) was associated with higher mortality (13 % vs 9 %) and complications (29 % vs 22 %), with risks 73 % and 52 % greater than those with glucose ≤6.1 mmol/L, and each 1 mmol/L rise increased complication risk by 3 %, independent of severity.

Abstract

OBJECTIVE— To examine whether hyperglycemia at the time of presentation was associated with outcomes in patients admitted to non–intensive care settings with community-acquired pneumonia (CAP). RESEARCH DESIGN AND METHODS— Prospective cohort study of consecutive patients admitted to six hospitals between 15 November 2000 and 14 November 2002. RESULTS— Of the 2,471 patients in this study (median age 75 years), 279 (11%) had serum glucose at presentation >11 mmol/l: 178 of the 401 patients (44%) with a prior diagnosis of diabetes and 101 of the 2,070 patients (5%) without a history of diabetes. Of patients hospitalized with CAP, 9% died and 23% suffered an in-hospital complication. Compared with those with values ≤11 mmol/l, patients with an admission glucose >11 mmol/l had an increased risk of death (13 vs. 9%, P = 0.03) and in-hospital complications (29 vs. 22%, P = 0.01). Compared with those patients with admission glucose ≤6.1 mmol/l, the mortality risk was 73% higher (95% CI 12–168%) and the in-hospital complication risk was 52% higher (12–108%) in patients with admission glucose >11 mmol/l. Even after adjustment for factors in the Pneumonia Severity Index, hyperglycemia on admission remained significantly associated with subsequent adverse outcomes: for each 1-mmol/l increase, risk of in-hospital complications increased 3% (0.2–6%). CONCLUSIONS— Hyperglycemia on admission is independently associated with adverse outcomes in patients with CAP, with the increased risks evident at lower glucose levels than previously reported.